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Policy recommendations from transmission modelling for the elimination of visceral leishmaniasis in the Indian subcontinent
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Le Rutte, Epke A., Chapman, Lloyd A. C., Coffeng , Luc E., Ruiz-Postigo, José A., Olliaro , Piero L., Adams , Emily R., Hasker , Epco C., Boelaert , Marleen C., Hollingsworth, T. Déirdre, Medley , Graham F. and de Vlas, Sake J. (2018) Policy recommendations from transmission modelling for the elimination of visceral leishmaniasis in the Indian subcontinent. Clinical Infectious Diseases, 66 (Supplement 4). S301-S308. doi:10.1093/cid/ciy007
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Official URL: https://doi.org/10.1093/cid/ciy007
Abstract
Background
Visceral leishmaniasis (VL) has been targeted by the World Health Organization (WHO) and five countries in the Indian subcontinent for elimination as a public health problem. To achieve this target, the WHO has developed guidelines consisting of four phases of different levels of control activities, based on vector control through indoor-residual spraying of insecticide (IRS) and active case detection (ACD). Mathematical transmission models of VL are increasingly used for planning and assessing the efficacy of interventions and evaluating the intensity and timescale required to achieve the elimination target.
Methods
This paper draws together the key policy-relevant recommendations from recent transmission modelling of VL, and presents new predictions for VL incidence under the control interventions recommended by the WHO using the latest transmission models.
Results
The model predictions suggest that the current WHO guidelines should be sufficient to reach the elimination target in areas that had medium VL endemicities (up to 5 VL cases per 10,000 population per year) prior to the start of interventions. However, additional interventions, such as extending the WHO attack phase (intensive IRS and ACD), may be required to bring forward elimination in regions with high pre-control endemicities, depending on the relative infectiousness of different disease stages.
Conclusions
The potential hurdle that asymptomatics, and in particular post-kala-azar dermal leishmaniasis cases (PKDL), may pose to reaching and sustaining the target needs to be addressed. As VL incidence decreases, the pool of immunologically naive individuals increases, which creates the potential for new large-scale outbreaks.
| Item Type: | Journal Article | ||||||||
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| Subjects: | R Medicine > RC Internal medicine | ||||||||
| Divisions: | Faculty of Science > Life Sciences (2010- ) Faculty of Science > Mathematics |
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| Library of Congress Subject Headings (LCSH): | Kala-azar -- Prevention -- Nepal, Kala-azar -- Prevention -- India, Kala-azar -- Prevention -- Bangladesh, Kala-azar -- Prevention -- Bhutan, Kala-azar -- Prevention -- Thailand | ||||||||
| Journal or Publication Title: | Clinical Infectious Diseases | ||||||||
| Publisher: | University of Chicago Press | ||||||||
| ISSN: | 1537-6591 | ||||||||
| Official Date: | 15 June 2018 | ||||||||
| Dates: |
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| Date of first compliant deposit: | 13 June 2018 | ||||||||
| Volume: | 66 | ||||||||
| Number: | Supplement 4 | ||||||||
| Page Range: | S301-S308 | ||||||||
| DOI: | 10.1093/cid/ciy007 | ||||||||
| Status: | Peer Reviewed | ||||||||
| Publication Status: | Published | ||||||||
| Access rights to Published version: | Open Access | ||||||||
| RIOXX Funder/Project Grant: |
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